Objectives: The purpose of this study was to compare the surgical outcomes of Polycel® and titanium in ossiculoplasty following tympanomastoidectomy (TM). Methods: A total of 221 patients underwent ossiculoplasty following TM by a single surgeon using either Polycel® or titanium as prosthesis. Hearing was tested preoperatively and postoperatively at 6 months by pure-tone audiometry. Successful surgery was defined if postoperative air-bone gap (ABG) was <20 dB, the gain in air conduction (AC) hearing was >15 dB HL, or postoperative AC was <30 dB HL. Multiple linear regression was conducted to identify the factors associated with the surgical outcomes. Results: In canal wall up mastoidectomy (CWUM), both Polycel® and titanium showed favorable successful rates if partial ossicular replacement prosthesis (PORP) was used (64.3% of Polycel® and 67.6% in titanium). If total ossicular replacement prosthesis (TORP) was used, both represented similar outcomes (54.5% of Polycel® and 75.0% in titanium). In canal wall down mastoidectomy (CWDM), significant ABG reductions were observed only in the titanium group (5.2 ± 14.7 dB of Polycel® [ P = .083] and 7.0 ± 14.2 dB of titanium [ P = .002] in PORP; 4.6 ± 13.5 dB of Polycel® [ P = .097] and 9.5 ± 11.2 dB of titanium [ P < .001] in TORP). In multivariate analysis, titanium had a positive effect on the reduction of postoperative AC thresholds (B: −4.772; 95% CI: −8.706-−0.838). Conclusions: Both Polycel® and titanium showed favorable surgical outcomes for ossiculoplasty following CWUM. Titanium prosthesis is recommended for surgery after CWDM.

Objectives: We suggest a simple measurement, called the “basal turn–facial ridge (BT–FR) angle,” for determining the electrode insertion axis using preoperative temporal bone computed tomography (CT) to predict hearing preservation (HP) in cochlear implantation (CI). Study Design: Retrospective chart review. Setting: Tertiary referral center. Patients: Eighty-two ears that underwent CI between 2010 and 2018 were included. Ears with preoperative thresholds less than or equal to 80 dB HL at 125, 250, and 500 Hz were enrolled and grouped using the criteria of Skarżyński et al.: Group 1, complete or partial HP; Group 2, minimal HP or complete hearing loss. Intervention: All subjects underwent CI with soft surgery techniques through the round window approach. Main Outcome Measures: The BT–FR angle is the angle between the basal turn line (BT-line), which is a straight line passing through the center of the longitudinal axis of the BT, and the facial ridge line, which is a straight line running from the endpoint of the BT-line to a point just above the facial ridge. Results: The BT–FR angle was 2.5 ± 2.9 degrees in Group 1 and –0.3 ± 2.7 degrees in Group 2 (p = 0.003). The angle and hearing loss showed a significant negative correlation (r = –0.401, p = 0.002). In multiple linear regression, “age at operation” (β coefficient 0.260; p = 0.001) and the “BT–FR angle” (–1.967; p = 0.001) were significant variables affecting the degree of residual hearing loss. Conclusions: The BT–FR angle, which can be measured simply, may be useful to predict residual HP after CI.

Objectives When there is a difference in hearing on both ears, where to perform the first cochlear implantation (CI) becomes an important issue. The purpose of the study was to evaluate which ear should be chosen for the first implantation in sequential bilateral CI with a long inter-implant period. Methods The study population consisted of 34 severe-to-profound sensorineural hearing loss pediatrics with the inter-implant period of ≥3 years between the first CI (CI-1) and the second CI (CI-2) before the age of 19 (mean of inter-implant period: 7.1-year). The patients were classified into Group A (CI-1 was performed on the ear with better hearing), Group B (CI-1 on the ear with worse hearing), or Group C (symmetrical hearing in both ears). Speech intelligibility test results were compared between the groups. Results The monosyllabic word scores of CI-1 were excellent in Groups A (91.7±7.9%) and B (92.5±3.6%) but slightly lower in Group C (85.7±14.9%) before the second implantation ( P = .487). At 3 years after the second implantation, all groups demonstrated excellent scores in the bilateral CI condition (95.9±3.0% in Group A; 99.1±.8% in Group B; 97.5±2.9% in Group C, P = .600). However, when the patients were tested in using CI-2 only in Groups A and B after using bilateral CI for 3 years, the scores were inconsistent in Group A (79.6±23.9%; range: 22.2-94.4%), while those were higher and more constant in Group B (92.9±4.8%; 86.8-100.0%). Conclusions The first CI is strongly recommended to perform on a worse hearing ear if they had different hearing levels between ears. Even with the first CI on a worse hearing ear, its performance never deteriorates. In addition, if they receive the second CI several years later, it will be likely that the second one functions better.

Objectives Patients with unilateral hearing loss (UHL) have difficulty in recognizing the direction of a sound. Previous studies have shown that hearing aids (HAs) could improve the directional perception of sound. In this study, we analyzed the results of sound localization tests in patients using a unilateral HA. Methods All patients with UHL who had performed sound localization tests since 2018 were included in this study. Sound localization tests, functional gain tests, and the speech discrimination scores (SDSs) were analyzed. The tests were obtained at 1‐, 3‐, and 6‐month after fitting the HA. Results Of the 32 patients with UHL, 13 were right‐sided and 19 were left‐sided. After 6 months of using a HA, the results of the sound localization test were significantly better in patients with right than left UHL (percent correct [PCT], 61.9 ± 24.0% vs. 37.9 ± 24.6%, p = .011; mean absolute error (MAE), 41.4 ± 23.9° vs. 65.5 ± 28.6°, p = .018; root‐mean‐square error (RMS), 25.8 ± 17.6° vs. 48.8 ± 24.5°, p = .007]. The aided SDSs were not different between the two groups (78.7 ± 16.5% vs. 77.2 ± 18.5%, p = .825). Conclusion The side of the hearing loss could have a substantial effect on sound localization in UHL patients using a HA. Sound localization test results should be interpreted with the consideration of this discordance. Level of Evidence 4

Objectives: The objectives of this study were to measure the changes in hearing thresholds in the same individuals during a period of 10 years and suggest a clinical reference for the threshold changes by aging. Methods: In this retrospective cohort study, we used regular health checkup data including 2 pure tone audiometry results with a 10-year interval in the same individuals from 1288 subjects. The subjects’ data including demographics, smoking habits, and the diagnosis of chronic diseases were used. Results: Age, male gender, smoking, and osteoporosis were identified as factors affecting age-related hearing loss (ARHL). The sole effect of aging on ARHL for 10 years according to age groups and genders was as follows: a loss of 1.4 dB in 20s, 4.0 dB in 30s, 5.0 dB in 40s, 8.2 dB in 50s, and 11.2 dB in 60s of males compared to a loss of 2.3 dB in 20s, 2.9 dB in 30s, 5.1 dB in 40s, 6.5 dB in 50s, and 9.4 dB in 60s of females. Conclusions: We could demonstrate the actual effect of aging on ARHL, and it can be used as a clinical reference. Hearing ability decreases more in males than females but seems to decrease exponentially with age in both males and females.

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It is widely accepted that extracts of St. John’s wort (Hypericum perforatum) improve depressive symptoms, and tinnitus patients commonly presented with either mild depression or anxiety. We investigated whether co-administration of St. John’s wort and Ginkgo biloba extracts can suppress tinnitus. Participants with subjective tinnitus aged 30–70 years were randomly assigned to the experimental (co-administration of St. John’s wort and Ginkgo biloba extract; n = 20) or control (Ginkgo biloba extract only; n = 26) group for 12 weeks. Participants were blinded to the group assignments. After 12 weeks of treatment, no significant change in the minimum masking level on the tinnitogram was observed in either group. In the co-administration group, the Tinnitus Handicap Inventory (THI) score decreased from 34.7 (SD, 15.9) to 29.6 (16.0) (p = 0.102). However, the control group showed a significant decrease in THI score, from 30.5 (16.7) to 25.6 (17.1) (p = 0.046). Regarding the Short Form-36 Health Survey (SF-36), only the “Social Functioning” domain score changed significantly after extract co-administration, from 74.5 (21.5) to 83.9 (20.5) (p = 0.047). Co-administration of St. John’s wort and Ginkgo biloba extracts did not improve the symptoms of subjective tinnitus compared to administration of Ginkgo biloba extract alone.

Objective In this prospective study, each subject experienced three modes electric acoustic stimulation (EAS), full electrical stimulation (FES), and electrical complement (EC), and the performance of each mode and subject preference were evaluated. Methods Eight ears (seven patients) with successfully preserved residual hearing after cochlear implantation (CI) were included. EAS, FES, and EC programs were set up on each patient's device, and each mode was used for at least 1 h per day for a month. The Speech Intelligibility test, the Speech, Spatial and Qualities of Hearing Scale, and the Hearing in Noise test (HINT) results in each stimulation mode. Results The mean monosyllabic word score (EAS: 90.3 ± 4.0; FES: 81.2 ± 16.1) and the mean sentence score (EAS: 98.3 ± 1.7; FES: 95.0 ± 3.0) were significantly higher in the EAS mode than in the FES mode. The mean bisyllabic word score (EAS: 95.6 ± 5.6; EC: 90.1 ± 5.6) was higher in the EAS mode than in the EC mode. In HINT, the signal‐to‐noise ratios under the noise front (EAS: 4.7 ± 2.5; FES: 7.9 ± 4.4) and noise composite conditions (EAS: 4.2 ± 2.7; FES: 6.6 ± 4.0) were significantly smaller in the EAS mode than in the FES mode. After trials of the three modes, five subjects preferred EAS, one preferred EC, and two preferred FES. Conclusion Among the three stimulation modes, EAS produced slightly better results, and subjects generally preferred EAS (five of seven patients, 71.4%). The use of hearing aids before CI was considered an important factor in mode preference. FES may be preferred when CI was performed at a young age and subjects had little experience with hearing aids. However, adults may prefer EC over EAS if there was little or no hearing‐aid use before CI.